Oral White Lesions Associated with Chewing Khat

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Khat is a cultivated plant whose leaves when chewed elevate mood. Unlike the chewing of betel nut, no association between the white oral mucosal lesions in khat users and oral malignancies has been reported. Chewing of khat has been documented in many countries and has increased with worldwide migration. The impact of chewing khat upon the oral mucosa is essentially unknown. Purpose The purpose of this study was to assess the occurrence of oral white changes in chronic khat chewers. Oral mucosal changes in a group of 47 Yemenite Israeli men over 30 years of age, who had chewed khat more than 3 years, were compared to those of 55 Yemenite men who did not chew. Results White lesions were significantly more prevalent in the khat chewers (83%) compared to the non chewing individuals (16%) (P < 0.001). White oral lesions were identified primarily on the lower buccal attached gingival mucosa, the alveolar mucosa and the lower mucobuccal fold on the chewing side (p < 0.001). There was no significant association between the occurrence of the white lesions and smoking. Even though the majority of the white lesions (85.4%) were homogenous, 71.4% of the non homogenous lesions were identified in khat chewers. Vital staining with toluidine blue and exfoliative cytology was conducted on a subset of patients with homogenous and non-homogenous oral lesions, and there were no findings suspicious for pre-malignant or malignant changes. Discussion This study demonstrated a relationship between khat chewing and oral white lesions, which we attribute to chronic local mechanical and chemical irritation of the mucosa. Our findings also suggest that mucosal changes associated with khat are benign, however, this initial study requires further studies including follow-up of khat users to confirm the current findings, including the likely benign changes associated with chronic use and histologic findings of clinical lesions.

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Publié le 01 janvier 2004
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TOBACCO INDUCED DISEASES© Vol. 2, No. 3: 145-150 (2004) PTID Society
Oral White Lesions Associated with Chewing Khat 1 2 3 1 Meir Gorsky, Joel B. Epstein, Harel Levi, Noam Yarom 1 Department of Oral Pathology and Oral Medicine, The Maurice and Gabriella Goldschleger 2 School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel; Medical-Dental Staff, British 3 Columbia Cancer Agency, Vancouver, B.C., Canada.; The Maurice and Gabriella Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel ABSTRACT:Introduction:is a cultivated plant whose leaves when chewed elevate Khat mood. Unlike the chewing of betel nut, no association between the white oral mucosal le-sions in khat users and oral malignancies has been reported. Chewing of khat has been documented in many countries and has increased with worldwide migration. The impact of chewing khat upon the oral mucosa is essentially unknown.Purpose:purpose of this The study was to assess the occurrence of oral white changes in chronic khat chewers. Oral mu-cosal changes in a group of 47 Yemenite Israeli men over 30 years of age, who had chewed khat more than 3 years, were compared to those of 55 Yemenite men who did not chew. Results:lesions were significantly more prevalent in the khat chewers (83%) com- White pared to the non chewing individuals (16%) (P<0.001). White oral lesions were identified primarily on the lower buccal attached gingival mucosa, the alveolar mucosa and the lower mucobuccal fold on the chewing side (p<0.001). There was no significant association be-tween the occurrence of the white lesions and smoking. Even though the majority of the white lesions (85.4%) were homogenous, 71.4% of the non homogenous lesions were identi-fied in khat chewers. Vital staining with toluidine blue and exfoliative cytology was con-ducted on a subset of patients with homogenous and non-homogenous oral lesions, and there were no findings suspicious for pre-malignant or malignant changes.Discussion:This study demonstrated a relationship between khat chewing and oral white lesions, which we attribute to chronic local mechanical and chemical irritation of the mucosa. Our findings also suggest that mucosal changes associated with khat are benign, however, this initial study requires further studies including follow-up of khat users to confirm the current findings, including the likely benign changes associated with chronic use and histologic findings of clinical le-sions. KEYWORDS: Khat, Oral Lesions INTRODUCTIONleaves and red leaves have stronger medical properties than the green leaves [4]. Cathinone, found in khat Catha edulis, also known as khat or qat, is a culti- leaves, is probably the alkaloid that has stimulating vated plant (Figure 1) whose chewed leaves cause ef- effects upon the central nervous system resulting in fects upon mood. It was first described in 1237 [1]. mood elevation and euphoria [3,5]. Khat is a green bush that is found mainly in East Afri- Khat leaves, which are generally placed in the can areas as well as in Saudi Arabia and Yemen [2,3]. mouth in the lower distal mucobuccal fold, are usually The medical properties vary based on the color of its chewed during social-cultural meetings where the
________________________________________ Correspondence:Dr. J. Epstein, Department of Oral Medicine and Diagnostic Sciences, 801 South Paulina St., Chicago, IL 60612, US Email: jepstein@uic.edu Fax: + 312-355-2688